Primary Syphilis

Syphilis is an infectious venereal disease caused by the spirochete Treponema pallidum. Syphilis is transmissible by sexual contact with infectious lesions, from mother to fetus in utero, via blood product transfusion, and occasionally through breaks in the skin that come into contact with infectious lesions.

If untreated, it progresses through 4 stages: primary, secondary, latent, and tertiary. Because the manifestations of syphilis (particularly advanced syphilis) are nonspecific and may masquerade as many other diseases, the physician must keep a high index of suspicion regarding the possible diagnosis of syphilis.

Primary syphilis Primary syphilis occurs within 3 weeks of contact with an infected individual. It manifests mainly on the glans penis in males and on the vulva or cervix in females. Ten percent of syphilitic lesions are found on the anus, fingers, oropharynx, tongue, nipples, fingers, or other extragenital sites

Treatment & Management

Penicillin is the treatment of choice for treating syphilis. Patients with known penicillin allergies should undergo penicillin allergy skin testing and penicillin desensitization, if necessary. The following regimens are recommended for penicillin treatment:

• Primary or secondary syphilis - Benzathine penicillin G 2.4 million units IM in a single dose
• Early latent syphilis - Benzathine penicillin G 2.4 million units IM in a single dose
• Late latent syphilis or latent syphilis of unknown duration - Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals
• Pregnancy - Treatment appropriate to the stage of syphilis is recommended.Tetracycline, erythromycin, and ceftriaxone have shown antitreponemal activity in clinical trials; however, they currently are recommended only as alternative treatment regimens in patients allergic to penicillin.